Retirement and nursing homes A particularly challenging part of the commissions’ work is finding ways of reducing the medication-based restriction of freedom and defining universal standards for violence prevention and averting health risks. Awareness of restrictions of freedom is increasing The deputy department head of the residents’ representatives at the VertretungsNetz association, Rosalinde Pimon, reported about current developments during the NPM’s annual exchange of experience and ideas. Whilst only approx. 8% of all mandatory reports pursuant to the Nursing and Residential Homes Residence Act (Heimaufenthaltsgesetz) in 2007 involved medication-based restrictions of freedom, the figure was some 40% in autumn 2019. According to the residents’ association VertretungsNetz, this is attributable to the awareness on the part of the caregivers and doctors in particular; a development that partially stems from the work of the NPM. According to observations by the NPM, the awareness that administering sedatives can be a restriction of freedom has increased in recent years. Every medication-based restriction of freedom also constitutes medical treatment. In order to assess the legality therefore, both the conditions of permissibility regulated in the Nursing and Residential Homes Residence Act and the general prerequisites for medical treatment must exist. The purpose of the medication or the therapeutic goal must also be clear before executing the measure. It must be possible to assess whether the medication constitutes a measure that restricts freedom. Administering medication without a therapeutic indication, but simply to suppress anxiety, constitutes an impermissible medication-based measure that restricts freedom and therefore also impermissible medical treatment. Disclosure of risk potential and therapeutic goal 33 There are still homes which, despite a large number of residents with suspected psychiatric diagnoses, avoid consulting doctors as well as contacting residents’ representatives associations. Commission 2 visited a home in Upper Austria, for example, which, at the time of the visit, had submitted no reports regarding medication-based restrictions of freedom even though the therapeutic goal of the prescribed and potentially sedating medication (e.g. Zyprexa, Praxiten, Dominal) could not be explained by the documented diagnoses alone. The medical documentation must always include the risk potential inherent in the relevant illness. A mere diagnosis without risk assessment is not sufficient and does not constitute a suitable legal basis for a measure that restricts freedom. The commission recommended an immediate examination by the attending general practitioners, to which the home agreed. Likewise in a recently opened home in Lower Austria, the management already conceded to Commission 6 in the final meeting that there were training needs and assured that they would contact the representatives of the residents. In a home in Vorarlberg Commission 1 observed that there were no psychiatric diagnoses for prescribed psychotropic medication.